SCPP FORM 6

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Work-Based Learning Evaluation Report

Trainee Supervisor/Mentor
Job Title Agency

Directions: Evaluate the personal qualities below for your trainee. Score the student by using the numerical key below to mark the appropriate space. List the specific job tasks that are performed by the student each grading period. Rate the student’s performance using the numerical key below. Your report will be used in determining a grade and for counseling the trainee. Careful attention should be given so as to present a true picture of your trainee’s work and progress each grading period.

Personal Qualities/Job Tasks Key: Excellent (9-10) Good (6-8) Fair (3-5) Poor (1-2) Unacceptable (0)

Rating of Trainee for Year -

Personal Qualities

Grading Period
1
2
3
4
5
6
Attendance:
Present and on time






Begins work promptly






Appearance: Clean, neat appearance, poise, orderly






Dependability: Able to work with little supervision, follows instructions, consistent






Leadership: Aggressive, eager to learn, resourceful, good judgment, able to inspire others






Thoroughness: Accurate, careful, completes work






Ability To Get Along With Others: Tactful, friendly, cooperative






Social Habits: Good attitude, self-control, honesty






Willingness to Work: Works overtime, performs extras






Progressive Job Tasks

(List specific job tasks performed from Training Plan.)

Grading Period
1
2
3
4
5
6






































































TOTAL (Personal Qualities + Job Tasks)






Average: Total ÷Total Possible Points







Evaluator’s Signature: Date: _